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Medical Care in Afghanistan - DoD Roundtable

This DoD Roundtable was perfectly timed for me! We were scheduled to participate and talk with U.S. Air Force Col. Schuyler K. Geller, command surgeon and commander, Medical Training Advisory Group at Camp Eggers, NATO Training Mission-Afghanistan/Combined Security Transition Command-Afghanistan. But earlier in the week I had to have some last minute, unscheduled foot surgery and did not know if I could attend. But the schedule did work out and after my very recent personal experience while being treated, I talked to Col Geller with an up to date appreciation for the wonderful abilities of our medical team in the United States (and medications to help reduce pain as well)!

Dr Geller commented on the Afghan security forces health care and their development of health care training programs. He had a very interesting perspective on Afghan health care and some statistics as well. According to the doctor, the biggest challenge that the Afghan military medical system has is a lack of doctors. Less than 40% of their authorized positions are filled! That is right! Wow! I bet they don’t complain about waiting in a doctor’s office for an hour like many Americans do. The nursing ranks are also below authorized numbers but new branch schools and some great trainers from the Nebraska National Guard are jump starting their program with 20 nurse graduates last year, 40 this year and moving up to 80 next year. They will meet their nurse goals in 2-2.5 years according to Dr Geller.

The military needs simple preventive measures to reduce the number of losses from injury and disease. While technology is not a problem with an adequate capability, simple vaccinations are due to lack of personnel to administer them. The military had 14,500 personnel removed from the force due to injury and disease during a time of war. The international community has poured funding in to Afghanistan to help develop their entire medical system. Almost a billion dollars was donated between 2002 and 2008 to help establish a national health care system. But to meet the needs of the military medical community two things need to happen according the colonel.

First, they must recruit more medical personnel, in particular doctors. Only one of three recruiter positions are filled and that continues to inhibit the number of new MDs. Second, quality must improve through training programs such as the nurse program with the Guard trainers. They need stronger ties with outside schools and better clinical training and faculty for the medical schools. Dr Geller said that within one year they will see improved faculty with ties to US and other university medical schools.

I asked about tapping into the resource of women medics and he said that the country does have a significant number of female nurses and some doctors. Most are in traditional roles for women such as OB/Gyn and pediatrics and are required to be in their home community and do not work at night. Most are in Kabul and no combat medics are women.

The entire Afghan medical system is complicated with five different medical systems ranging from the military system to private and outside Non Governmental Organizations (NGOs). He said the Afghan population has low confidence in the public health care system and that they do have guaranteed health care coverage. He said 57-59% of Afghans go to private system medics on their first visit and pay out of pocket costs instead of using the government provided programs. This increases to 75% on the second visit which further shows the lack of confidence. Again, out of pocket payments to see a doctor/nurse in whom they have confidence in a very poor country. With a national system that sends folks to private doctors due to a quality issue it might create a pause for any country changing to a national health care system to avoid creating similar problems. Not to mention the lack of doctors in their military to care for those who are serving and protecting.

In closing, Dr Geller said that the medical system returns value and that it is worth our efforts to improve. He predicted that within 4-5 years quantity and quality problems will be significantly resolved allowing withdrawal of allied medical resources. I hope my foot is healed by then!

Master Sergeant Craig Abrom asks random medical questions during a hands-on vital signs training course with Afghan National Army soldiers participating in the Combat Medic Course in Kabul, Afghanistan. Sergeant Abrom is a mentor assigned to the Combat Medic School.

Can You Feel a Pulse?Photo by Tech. Sgt. Cecilio M. Ricardo Jr., USAF

Master Sgt. Sherri Taru shows Afghan National Army soldiers how to find a pulse and check vital signs during the hands-on portion of the Combat Medic Course in Kabul, Afghanistan. Airmen and Soldiers mentor ANA instructors throughout the Combat Medic course. Each class has approximately 65 to 90 trainees.

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